Failed Trapeziectomy Treated by Thumb Metacarpal Base Arthrodesis: A Case Series.

Trapeziometacarpal joint arthritis is a prevalent condition with a preponderance to women. Most cases are asymptomatic, but typical symptoms are pain, reduced dexterity, and functional decline. Trapeziectomy is the most common surgical treatment in the United Kingdom for patients who remain significantly symptomatic despite nonoperative measures, and this generally produces acceptable outcomes; however, a proportion of patients remain significantly symptomatic. The authors present a case series of 4 patients who underwent successful thumb metacarpal base to index metacarpal base arthrodesis with either distal radial or iliac crest bone grafting. Three of these patients had persisting symptoms after a primary trapeziectomy and 1 patient had gross subluxation of the thumb related to rheumatoid arthritis. Technically, this is a simple procedure to perform. All patients had improved symptoms with satisfactory functional outcomes and an improved cosmetic appearance of the hand.

The Routine Use of Cholangiography for Laparoscopic Cholecystectomy in the Modern Era.

BACKGROUND AND OBJECTIVES: The use of routine versus selective intra-operative cholangiogram (IOC) for laparoscopic cholecystectomy (LC) remains an area of debate. In this study, we investigated the routine use of IOC in a single center, to determine whether it confers a reduced risk of common bile duct (CBD) injury and improved patient outcomes. We also identified several preoperative predictive factors for CBD stone detection on IOC to investigate the feasibility of a predictive model. METHODS: We identified 1005 LCs with routine IOC over a 2-year period at the Norfolk and Norwich University Hospital from October 1, 2013, to September 30, 2015. Outcomes measured included CBD stone detection on IOC, CBD injury, complication rates, readmission rate, and mortality. We also calculated sensitivity, specificity, and likelihood ratios for detection of CBD stones on IOC from preoperative biochemistry and radiological investigations. RESULTS: We identified a CBD stone detection rate of 10.1% and a readmission rate of 0.03%, with no reported CBD injuries and 1 reported mortality. Of the preoperative predictive factors investigated, the most specific for CBD stone detection on IOC was bilirubin at 89%. The most sensitive was preoperative MRCP at 77%. DISCUSSION: This study demonstrates that routine IOC is an effective method of detecting CBD stones and CBD injuries, resulting in improved patient outcomes and economic benefits for health services. We have also identified several predictive factors for CBD stones on IOC.

Effect of Social Deprivation on the Stage and Mode of Presentation of Colorectal Cancer.

PURPOSE: Based in a hospital serving one of the most deprived areas in the United Kingdom (UK), we aimed to investigate, using the Indices of Deprivation 2010, the hypothesis that deprivation affects the stage and mode of presentation of colorectal cancer. METHODS: All newly diagnosed patients with colorectal cancer presenting to a District General Hospital in the UK between January 2010 and December 2014 were included. Data were collected from the Somerset National Cancer Database. The effect of social deprivation, measured using the Index of Multiple Deprivation Score, on the stage and mode of presentation was evaluated utilizing Microsoft Excel and IBM SPSS ver. 22.0. RESULTS: A total of 701 patients (54.5% male; mean age, 76 years) were included; 534 (76.2%) underwent a surgical procedure, and 497 (70.9%) underwent a colorectal resection. Of the patients undergoing a colorectal resection, 86 (17.3%) had an emergency surgical resection. Social deprivation was associated with Duke staging (P = 0.09). The 90-day mortality in patients undergoing emergency surgery was 12.8% compared to 6.8% in patients undergoing elective surgery (P = 0.06). No association was found between deprivation and emergency presentation (P = 0.97). A logistic regression analysis showed no increase in the probability of metastasis amongst deprived patients. CONCLUSION: This study suggests an association between deprivation and the stage of presentation of colorectal cancer. Patients undergoing emergency surgery tend to have a higher 90-day mortality rate, although this was not related to deprivation. This study highlights the need to develop an individual measure to assess social deprivation.